Experience of pediatric rapid response team in a tertiary care hospital in Pakistan.

Objective. To report our experience before and after implementation of pediatric rapid response team (RRT) in pediatric wards of a tertiary care hospital in Pakistan. Methods. An audit of RRT activity from December 2007 to August 2008 was conducted and reviewed patient diagnoses at the time of call placement, interventions done and post-intervention clinical outcomes. Clinical Outcomes in the nine months before RRT implementation were compared with those in the first operational nine months after RRT. Results. Eighty-three calls were generated during the post-intervention study period of 9-month (21 calls/1000 admissions). The median age of patients was 27 months; 37% calls were for infants. The majority of patients were under care of medical services (93% vs 7% under care of surgical services). Greater numbers of calls were made during 0800-1600 hours (45%). Respiratory issues were the most common reason for activation of RRT. Because of early interventions, majority (61%) of patients avoided unnecessary PICU stay and expenditure; only 17% required mechanical ventilation in PICU. The code rate per 1000 admissions decreased from 5.2 (pre-RRT) to 2.7 (post-RRT) (p=0.08; OR 1.88(95%CI 0.9 -3.93). The mortality rate of patients admitted in PICU from wards decreased from 50% to 15% (p=0.25; OR 1.64 (95%CI 0.63 – 4.29). Conclusion. Our experience with implementation of RRT was associated with reduction in cardiorespiratory arrest, mortality and saved a lot of PICU resource utilization. It is an excellent patient-safety initiative especially in resource-constrained countries by bringing PICU reflexes outside the PICU.

On admission hypomagnesemia in critically Ill children: Risk factors and outcome.

Objective. To determine the frequency and associated risk factors of hypomagnesemia in pediatric intensive care unit on admission in a developing country. Methods. It is a retrospective chart review of 179 children aged 1 mo – 15yr admitted in Pediatric Intensive Care Unit of our university during 18 months and recorded serum Mg level on admission. Patients were divided into two groups according to their Mg level (Normo-magnesemic and Hypomagnesemic) and their p-value, crude and adjusted odds ratios (AoR) were calculated. Results. Upon admission in PICU 79(44%) patients were found hypomagnesemia. There was no difference in age and gender between two groups. The important risk factors identified were age greater than one yr (p 0.05, AOR 3.71), sepsis (p 0.03, AOR 3.11), hypokalemia (p 0.06, AOR 1.8), hypocalcemia (p 0.05, AOR 1.6), diuretic use (p 0.05, AOR 1.37), Aminoglycoside use (p 0.003, AOR 3.12), and hospitalization greater than five days (p 0.03, AOR 1.71). Those with normomagnesemic had higher mortality rate (32/100 or 32%) than those with hypomagnesemia (22/79 or 27.8%). Conclusion. The present finding indicates that hypomagnesemia is a common among PICU patients and is influenced by several factors.

Measles in children younger than 9 months in Pakistan.

Pakistan has one of the highest burden of measles and measles-related deaths in the world. We compared the clinical course and outcomes of measles in infants aged £9 months with those >9 month old amongst children admitted to a tertiary care hospital. Data were collected by a retrospective chart review, and compared between age £9 months (Group A) and age >9 months (Group B). Severe malnutrition (P=0.039, adjusted odds ratio=3.02), anemia (P=0.017), leukocytosis (P<0.001, adjusted odds ratio 4.1), and conjunctivitis (P=0.021) were higher in Group A children. All four deaths occurred in Group B.

Does prophylactic use of dexamethasone have a role in reducing post extubation stridor and reintubation in children.

All children aged from 4 weeks to <5 year, were intubated for at least 48 hours [n=51] during 6 months. Data of the patients treated with DEX (0.5 ml/kg every 6 hours for 3 doses, beginning 6-12 hours prior to extubation) (n=30) were compared with control patients (who had not received medication) (n=21). The DEX and control groups were similar in age i.e., mean ages of DEX group were 16.85±14 months, and that of control group were 19.02 ± 19 months, mean duration of intubation and mechanical ventilation in DEX group was 5.17 ± 4.58 days, and that in control group was 3.98 ± 3.60 days. There was no significant difference between DEX and control group in the incidence of postextubation stridor [17% (5/30) vs. 10% (2/ 21); p = 0.5] and the reintubation rate [7% (2/30) vs. 10% (2/21); p = 0.7]. Our data revealed that the prophylactic use of dexamethasone in planned extubation of high risk children were not effective.